Clinical Question

Does a conservative fluid management strategy improve survival and other outcomes in patients with acute lung injury compared to a liberal fluid management strategy?

Bottom Line

A conservative fluid management strategy did not significantly reduce 60-day mortality but improved lung function and shortened the duration of mechanical ventilation and intensive care without increasing nonpulmonary-organ failures compared to a liberal fluid management strategy.

Major Points

The Fluid and Catheter Treatment Trial (FACTT) examined the effects of a conservative versus liberal fluid management strategy on mortality and ventilator-free days in patients with acute lung injury. While no significant difference in 60-day mortality was observed, patients in the conservative-strategy group had better lung function and fewer days on mechanical ventilation and in intensive care.

Guidelines

Current evidence does not support a definitive guideline for liberal or conservative fluid management in patients with established acute lung injury.

Design

Multicenter, randomized, controlled trial with explicit protocols for conservative or liberal fluid management applied for seven days in 1,000 patients with acute lung injury

Population

1,000 patients with acute lung injury, intubated, and receiving positive-pressure ventilation.

Interventions

Participants were randomized to receive a conservative or liberal strategy of fluid management.

Outcomes

Primary Outcome: Death from any cause at 60 days. Secondary Outcomes: Number of ventilator-free days, organ-failure–free days, and measures of lung physiology.

Criticisms

The study focused on a 7-day intervention and may not have captured long-term sequelae of fluid management strategies.

Funding

Supported by contracts with the National Heart, Lung, and Blood Institute, National Institutes of Health. No potential conflict of interest relevant to this article was reported.

FACTT